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Managing Tooth Decay In Children With Chronic Diseases

Poor oral health puts kids with special needs at risk

By Dr. Donald L. Chi and Dr. Peter Milgrom



Xylitol is a naturally occurring sweetener that improves oral health. It looks and tastes like table sugar and can be purchased for use on cereal and other foods. There is strong research evidence showing the benefits of adding xylitol to the diet of preschoolers at risk for tooth decay. A recent study of children aged 15-30 months found that two tablespoons of xylitol syrup (xylitol, water, and flavoring) squirted on to the teeth two to three times per day reduced tooth decay by as much as 70%. Xylitol use also complements the effects of fluoride and has few side effects.

Mother teaching child how to brush her teeth.
Whether you start out by brushing your children's teeth or demonstrating and watching them successfully perform oral hygiene techniques, you are establishing proper hygiene practices that will last a lifetime.
Brothers learning how to brush from eachother.
Sometimes, the best motivation and stimulation for shaping oral hygiene behavior is the inspiration of an older sibling acting as a role model.
Oral Hygiene Practices

Depending on the degree of physical and mental abilities, healthy dental habits may be difficult to provide for your children.

“Modeling and shaping” behavior are useful techniques when training individuals in proper oral hygiene. For example, tooth-brushing for a child will help them learn the necessary motion to use and the feel of clean tooth surfaces. The feel of clean teeth provides self-evaluation and reinforces positive behavior and change. Try to establish a routine and healthy habits at a young age. Your child may also respond to brushing with a sibling for example. Children are powerful role models for other children, which may also be reinforcing.

If you have very limited cooperation, gentle positioning of a child “knee-to-knee” makes it easier to brush the child's teeth. A second toothbrush can be used as a mouth prop to help keep the child from clenching or biting. For children who cannot swallow or rinse, cotton gauze can be used to dry the teeth after brushing. When it comes time to find a dentist, it is important to find a dentist who is trained to treat special needs children. Caregivers need to be comfortable, and dental offices that allow caregivers to remain by the child's side during dental appointments may also be important to you and your child.

Dietary Practices

Children requiring special diets (e.g., nutritional shakes or beverages, and frequent feedings to boost their calorie-intake) have an increased need for dental visits, especially when very young. Parents also need to be trained and vigilant regarding the signs of developing tooth decay.

Weaning children from bottles and training cups as early as possible, and encouraging the use of open cups filled with milk or preferably with water is recommended.

To soothe children during naps or bedtime, many caregivers fill bottles or no-spill training cups with sugary beverages such as juice, or coat pacifiers with honey. This practice greatly exacerbates the risk for tooth decay. Juice diluted with water is as bad for the teeth as undiluted juice. Weaning children from bottles and training cups as early as possible, and encouraging the use of open cups filled with milk or preferably with water is recommended.

Chronic Medication Use

Children with chronic health conditions commonly require medications to treat their medical conditions, e.g., antidepressants, antihistamines, antitussives (for coughing), bronchodilators (to assist breathing), and mucolytics (to break up mucus). Many of these cause mouth dryness, greatly increasing risk for tooth decay. Many of these medications also contain sugar and are acidic, factors that contribute to tooth decay. In consultation with the child's physician, medications should therefore be given to the child during mealtimes whenever possible.

Consequences Are Not Inevitable

The consequences of untreated tooth decay include sensitivity while eating, pain and gum abscesses, all of which lead to poor oral and general health, impacting quality of life. Children with tooth decay also have: greater need for invasive dental treatments; fillings, baby-tooth root canals, crowns, and extractions; hospitalization; in rare cases, systemic (generalized) infections that can lead to death if left untreated. The health-related and social consequences of poor oral health for children with special needs highlight the importance of preventing dental caries (tooth decay) and managing the results of disease with the least invasive dental treatments possible. But these consequences are not inevitable. Dental care and healthy mouths are a critical part of overall health and well-being. Our children are our future, and all children are special.